PRÉCIS:The presence of anterior capsular laxity caused acute angle closure glaucoma, and posterior capsular laxity alone was associated with a chronic progressive course, revealing new insight into the pathogenesis of primary angle closure disease. PURPOSE:This study investigates the association between anterior or posterior capsular bag laxity during cataract surgery and clinical characteristics in patients with primary angle closure disease (PACD). METHODS:This retrospective study included 137 patients (200 eyes) diagnosed with PACD and undergoing phacoemulsification cataract surgery. Patients were categorized into 4 groups based on the condition of the capsular bag: loose anterior capsular bag (LACB), loose posterior capsular bag (LPCB), loose anterior and posterior capsular bag (LAPCB), and stable capsular bag (SCB). We analyzed the association of capsular bag laxity with clinical characteristics using ANOVA and χ 2 . RESULTS:Significant differences were observed among the groups in terms of sex, disease duration, anterior chamber depth (ACD), lens vault (LV), and lens Front R, while age, PACD classification, mean corneal power, axial length, and lens thickness showed no significant variation. The ACD was notably deeper in the LPCB and SCB groups. The LV was higher, and the lens Front R was smaller in the LACB and LAPCB groups. Lens Back R varied more in the LPCB group. Anterior capsular laxity, alone or combined with posterior capsular laxity, was more prevalent in cases of acute angle closure glaucoma (ACG) (56.0%) compared with chronic ACG (19.4%). Posterior capsule laxity alone was more common in chronic ACG (45.2%) than in acute ACG (10.7%). CONCLUSION:The presence of anterior capsular laxity, with or without posterior capsular laxity, is associated with the development of acute ACG, whereas posterior capsular laxity alone is typically linked to the development of chronic ACG.

BACKGROUND:This study aims to investigate the morphologic features of the crystalline lens in Primary Angle Closure Disease (PACD) patients with zonular instability during cataract surgery using the swept-source CASIA 2 Anterior Segment-Optical Coherence Tomography (AS-OCT) system.METHODS:A total of 398 eyes (125 PACD eyes with zonular instability, 133 PACD eyes with zonular stability, and 140 cataract patient controls) of 398 patients who underwent cataract surgery combined or not glaucoma surgery between January 2021 and January 2023 were enrolled. The crystalline lens parameters were measured by CASIA2 AS-OCT. Then, logistic regression was performed to evaluate the risk factors associated with zonular instability.RESULTS:The results revealed that PACD eyes had a more anterior lens equator position, a steeper anterior curvature of lens, shorter Axial Length (AL), shallower Anterior Chamber Distance (ACD), higher Lens Vault (LV) and thicker Lens Thickness (LT), when compared to eyes in the cataract control group. Furthermore, PACD eyes in the zonular instability group had steeper front R, front Rs and Front Rf, flatter back Rf, thicker lens anterior part thickness, higher lens anterior-to-posterior part thickness ratios, shallower ACD, and greater LV, when compared to PACD eyes with zonular stability. The logistic regression analysis, which was adjusted for age and gender, revealed that zonular instability was positively correlated with anterior part thickness, lens anterior-to-posterior part thickness ratio, and LV, but was negatively correlated with lens anterior radius and ACD.CONCLUSION:Steeper anterior curvature, increased lens anterior part thickness, higher anterior-to-posterior part thickness ratio, shallower ACD, and greater LV are the anatomic features of PACD eyes associated with zonular instability.

To systematically review the characteristics of patients experiencing acute angle closure (AAC) attacks during the COVID-19 outbreak in Beijing. Patients with AAC attacks during the COVID-19 epidemic and those in the same period the following year were recruited. Demographic characteristics, ocular biometry, ocular signs, sequential relationships, and the prognosis of operative management outcome were recorded and compared between the 2 groups. We included 60 eyes of 55 patients with AAC attacks in the COVID-19 group and 34 eyes of 33 patients in the control group. There was a significantly higher incidence of bilateral attacks during the COVID-19 outbreak compared to the control group (9 vs 1, P = .043). Additionally, a higher proportion of AAC attacks were observed in the COVID-19 group (P = .035). The COVID-19 group had a higher mean peak intraocular pressure (53.42 ± 8.87 mm Hg vs 47.86 ± 11.22 mm Hg; P = .007), larger pupil diameter (5.75 ± 1.04 mm vs 4.86 ± 1.26 mm; P < .001), more pigmented keratic precipitates (39 vs 8, P < .001), and segmental atrophy of the iris (32 vs 10, P = .019). Coronavirus infection was simultaneous with or slightly preceded the appearance of AAC attacks. Most patients had an ideal prognosis after comprehensive management. An increased incidence of AAC attacks, more bilateral cases and severe anterior segment inflammation were observed during the COVID-19 outbreak in Beijing. There may be a correlation between the onset of AAC attacks and coronavirus infection, but further research is needed to explore this link.

Purpose: To investigate the effects of anterior chamber pigment dispersion on ocular immune privilege and the possible mechanisms involved in a DBA/2J mouse model of pigmentary glaucoma. Methods: DBA/2J mice were utilized as a pigment dispersion model, and age-matched C57BL/6J mice were used as the control group in this study. Proteins in the aqueous humor (AH) and serum were quantified using the bicinchoninic acid assay. Immune cells in the AH were detected using hematoxylin and eosin staining and immunocytochemistry. The expression of TGF-β2 in the AH and cytokine levels (IL-10, IFN-γ) in serum were measured using ELISA. Anterior chamber-associated immune deviation (ACAID) was induced in DBA/2J mice by injecting antigens into the anterior chamber. Delayed-type hypersensitivity (DTH) assays were used to assess the induction of ACAID. In DBA/2J mice, before and after pigment dispersion, following anterior chamber injection of pigment particles, and after ACAID modeling, the expression of regulatory T cells (Tregs) was detected using flow cytometry. Results: Compared to C57BL/6J mice, the protein concentration, immune cell count, and TGF-β2 levels in the AH were elevated in DBA/2J mice. Protein concentration and IL-10 levels in serum were increased, while IFN-γ levels were decreased in DBA/2J. Additionally, the expression of Treg cells in the spleen of DBA/2J mice was significantly increased after pigment dispersion and anterior chamber injection of pigment particles. At 3 and 6 months, DTH responses in DBA/2J mice were not inhibited, thus preventing ACAID induction. However, the opposite was observed at 9 months in DBA/2J mice. Furthermore, the ACAID group exhibited an augmented expression of Treg cells. Conclusions: Dispersion of pigment particles in the anterior chamber of the eye enhances the state of ocular immune privilege by influencing the immunosuppressive microenvironment and inducing more Treg cells to reestablish ACAID.

Normal tension glaucoma (NTG) is a specific subtype of glaucoma in which patients with intraocular pressure (IOP) fluctuating within the normal range still present with progressive retinal ganglion cell damage and glaucomatous visual field loss. Numerous studies have proved that non-IOP factors play an essential role in the pathogenesis of NTG, among which blood flow abnormalities have received more attention. Hemodynamic abnormalities such as topical ocular hypoperfusion, systemic hypotension, and vascular dysregulation can lead to inadequate perfusion pressure and blood supply to the optic nerve head in NTG patients, thereby causing the progress of NTG. Therefore, treating the abnormal blood flow status in NTG patients becomes an etiological treatment in addition to lowering the IOP. ( Int Rev Ophthalmol, 2023, 47: 302-307)

Normal-tension glaucoma (NTG) is a chronic progressive optic neuropathy, in which the intraocular pressure (IOP) is within the normal range. More and more evidence shows that NTG accounts for a high proportion of open-angle glaucoma. In the diagnosis of NTG, 24-hour IOP measurement is particularly important, and it is the main sign to differentiate NTG from POAG. The 24-hour IOP monitoring of NTG patients usually shows peak intraocular pressure at night, and the diurnal fluctuation of IOP is often larger than normal. In addition, the average IOP, short-term and long-term IOP fluctuation amplitude and minimum IOP value of 24 h IOP are all the predictive parameters of NTG disease progression. This makes the 24-hour IOP monitoring of NTG patients and individualized treatment based on the characteristics of their 24-hour IOP fluctuation become particularly important. ( Int Rev Ophthalmol, 2023, 47: 24-29)

The discovery of the necroptosis, a form of regulated necrosis that is mediated by receptor-interacting protein kinase 1 (RIPK1), RIPK3, and mixed-lineage kinase domain-like pseudokinase (MLKL), represents a major breakthrough that has dramatically altered the conception of necrosis - traditionally thought of as uncontrolled cell death - in various human diseases. Retinal cell death is a leading cause of blindness and has been identified in most retinal diseases, e.g., age-related macular degeneration, glaucoma, retinal detachment, retinitis pigmentosa, etc. Increasing evidence demonstrates that retinal degenerative diseases also share a common mechanism in necroptosis. Exacerbated necroptotic cell death hinders the treatment for retinal degenerative diseases. In this review, we highlight recent advances in identifying retinal necroptosis, summarize the underlying mechanisms of necroptosis in retinal degenerative diseases, and discuss potential anti-necroptosis strategies, such as selective inhibitors and chemical agents, for treating retinal degenerative diseases.

目的 探讨色素性青光眼动物模型DBA/2J小鼠房水引流通道中色素颗粒形态、大小、数量与眼压之间的关系.设计实验研究.研究对象9周龄雄性DBA/2J小鼠20只(40眼).方法 定期监测眼压和眼前节变化,12、20、28、36周龄随机各取3只(6眼),按眼压正常与否分成正常眼压和高眼压组.光镜观察不同眼压组房水引流通道结构及其内色素颗粒的分布.透射电镜观察前房和小梁网内色素颗粒的形态,用Image软件随机测量100个色素颗粒的直径,并比较不同眼压组小梁网内色素颗粒直径的差异.主要指标眼压,前房和小梁网内色素颗粒的直径.结果 DBA/2J小鼠从20周龄起出现虹膜色素颗粒脱失、播散,虹膜基质萎缩伴透照缺损.12和20周龄小鼠均未出现高眼压,28和36周龄分别有36.4％和75％的小鼠眼压升高.不同周龄间眼压差异有统计学意义(x2=37.82,P＜0.001).与正常眼压组相比,高眼压组虹膜厚度变薄,前房内和虹膜前、后表面富含色素颗粒的细胞堆积,前房角变窄,小梁网内大量色素颗粒沉积.DBA/2J小鼠前房内色素颗粒的形状为圆形,平均直径(0.44±0.12 μm);或椭圆形,平均长度(0.77±0.20 μm).58.6％的圆形色素颗粒直径和63.3％的椭圆形色素颗粒长度集中在0.40～0.80 μm.正常眼压组小梁网内53.3％的圆形色素颗粒直径和100％的椭圆形色素颗粒长度大于0.40 μm;高眼压组小梁网内100％的圆形色素颗粒直径和100％的椭圆形色素颗粒长度均大于0.40 μm.高眼压组小梁网内圆形色素颗粒的直径(0.58±0.11)和椭圆形色素颗粒的长度(0.90±0.12)均大于正常眼压组(0.42±0.12 μm、0.72±0.12 μm),差异有统计学意义(t=-6.82,-4.657;P均＜0.001).结论 DBA/2J小鼠房水引流通道中最大容许通过直径为0.40 μm,大于此直径的色素颗粒沉积引流通道狭窄处并引起阻塞是其眼压升高的主要原因.

Purpose: To characterize the distribution of pigment particles in aqueous drainage structures of DBA/2J mice with different intraocular pressure (IOP) levels. Methods: DBA/2J mice were monitored from 9 to 44 weeks of age. IOP measurements were performed periodically. At 12, 20, 28, and 36 weeks, three mice were randomly selected for each time point and divided into three IOP groups. The morphology, size, and quantity of pigment particles in aqueous drainage structures were determined via transmission electron microscopy combined with ImageJ-based analysis. Between-group differences were evaluated with a one-way analysis of variance and Fisher's least significant difference test. Results: In the anterior chamber, 74.2% (187/252) of pigment particles were round (diameter range, 0.20–0.73 µm), and 25.8% (65/252) were oval (length range, 0.35–1.20 µm ). In the high-IOP group (IOP≥15 mmHg), pigment particles in the trabecular meshwork (TM) were more abundant and larger in size than those in the normal-IOP group (P<0.001). All separate pigment particles in the TM of the high-IOP group were >0.4 µm in size. The diameters of round (IOP≤10 mmHg, 0.44±0.13 µm; IOP between 10 and 15 mmHg, 0.57±0.13 µm; IOP≥15 mmHg, 0.61±0.12 µm) and the lengths of oval (0.65±0.14 µm vs. 0.77±0.12 µm vs. 0.88±0.15 µm, respectively) pigment particles in the TM differed among groups (F=27.258 and F=27.295, respectively; both P<0.001). No such differences were discovered in the iris and around Schlemm's canal (P>0.05). Conclusions: In DBA/2J mice, large and medium pigment particles (>0.4 µm) seem to play an important role in causing aqueous outflow obstruction and IOP elevation.

Pigmentary glaucoma is a kind of secondary open-angle glaucoma with relatively simple pathogenesis. The main reason for elevated intraocular pressure is increased aqueous outflow resistance owing to an accumulation of pigment granules in the trabecular meshwork. These pigment granules can not only cause mechanical obstruction of the intertrabecular spaces, but also lead to the loss of trabecular cells which had overload phagocytized pigment granules, the fusion of trabecular lamellae with collapse of intertrabecular spaces, and the obliteration of the canal. In recent studies, the aqueous humor dynamic changes in the uveosceleral outflow pathway, complex molecular genetics and immune mechanism might be involved in the pathogenesis of pigmentary glaucoma. ( Int Rev Ophthalmol, 2021, 45: 183-187)

目的 探讨原发性闭角型青光眼(primary angle closure glaucoma,PACG)白内障手术中发现晶状体悬韧带异常患者的生物学测量参数特征.设计回顾性比较性病例系列.研究对象2019年5月至2020年12月北京同仁医院连续的PACG术前未明确悬韧带异常、白内障术中发现悬韧带异常者(术中悬韧带异常组)45例(45眼),PACG悬韧带无异常者95例(95眼),术前即诊断为晶状体不全脱位继发闭角型青光眼者41例(41眼),共181例181眼.方法 回顾三组患者的病例资料.比较三组患者的IOLmaster和UBM的生物学测量参数.主要指标前房深度、晶状体拱高、晶状体厚度、眼轴长.结果 术中悬韧带异常组和悬韧带无异常组的前房深度[(1.61±0.31)mm、(1.74±0.35)mm,P=0.074]和眼轴长[(22.07±0.78)mm、(22.20±0.75)mm,P=0.650]无统计学差异.晶状体拱高在术中悬韧带异常组、悬韧带无异常组和晶状体不全脱位组分别为[(1.41±0.35)、(1.04±0.21)、(1.73±0.45)mm,P=0.000];两两比较中差异均有统计学意义.术中悬韧带异常眼的晶状体拱高[(1.42±0.25)mm]、高于对侧健眼[(1.24±0.27)mm](P=0.049).晶状体厚度在术中悬韧带异常组和晶状体不全脱位组[(5.14±0.26)、(5.18±0.29)mm,P=0.808]中无统计学差异,但较悬韧带无异常组[(4.89±0.31)mm,P=0.001]增厚.术中悬韧带异常组患者80％晶状体拱高＞1.2 mm,晶状体厚度＞4.9 mm.结论 PACG患者白内障手术前晶状体拱高超过1.2 mm同时晶状体厚度超过4.9 mm时应警惕晶状体悬韧带异常的可能.

青光眼是一组以视网膜神经节细胞慢性进行性损伤为病理特征,伴有特征性视乳头杯盘比扩大、视网膜神经纤维层缺损及相应视野缺损的视神经病变,是目前世界范围内主要的不可逆性致盲眼病 [1].在青光眼的发生和进展中,目前唯一被确定的因素是病理性的绝对或相对眼压升高,并超过视乳头巩膜筛板的承受能力,导致后者变形、扭曲,从筛孔中穿越的视网膜神经节细胞(retinal ganglion cells, RGCs)轴索受挤压,引起轴浆流运输障碍或阻断,导致受压RGCs凋亡.降低眼压可延缓甚至阻止青光眼病理改变的进展,是目前通用的治疗手段.

To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block. Twenty one eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6 months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline. Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 +/- 6.93 years (range, 31-55 years) at initial diagnosis. The mean IOP level was 33.1 +/- 9.8 mmHg (range, 22-56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15-16) on admission, which changed to 14 (IQR, 13-15), 13 (IQR, 12-14), 12(IQR, 10.5-12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1 +/- 3.4 mmHg. TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants.

目的 评价他氟前列素滴眼液对正常眼压性青光眼(normal tension glaucoma,NTG)的临床治疗效果及安全性.方法 采用前瞻性队列研究方法,选择2019年1月1日至2020年8月31日在首都医科大学附属北京同仁医院眼科首诊的NTG患者56例,随机选取1只眼作为研究眼,入选后给予他氟前列素滴眼液治疗,连续3个月.比较用药前后的眼压、最佳矫正视力、视野平均缺损、视野指数、视盘周围毛细血管密度及视盘周围视网膜神经纤维层平均厚度,并观察药物不良反应的发生情况.结果 56例患者中男18例,女38例,平均年龄(45.9±10.7)岁,均为双眼发病.入选的56只眼治疗前平均眼压为(16.67±2.67)mmHg,治疗3个月后平均眼压为(13.52±2.08)mmHg,平均降低幅度为18.9％,治疗前后比较差异有显著性(P=0.007).与未接受治疗时的基线眼压相比,有8.93％(5/56)眼的眼压降低幅度≥30％,66.07％(37/56)眼的眼压降低幅度≥15％,其他眼的眼压降低幅度＜15％.治疗前后的最佳矫正视力、视野平均缺损、视野指数、视盘周围毛细血管密度、视盘周围视网膜神经纤维层平均厚度比较差异均无显著性(P＞0.05).4例患者出现中度结膜充血或异物感,无其他明显不良反应发生.结论 他氟前列素滴眼液可有效降低NTG患者的眼压,结膜充血是其常见并发症.

To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block. Twenty one eyes of 11 PDS patients were followed up periodically for 15years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline. Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25±6.93 years (range, 31–55years) at initial diagnosis. The mean IOP level was 33.1±9.8mmHg (range, 22–56mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15–16) on admission, which changed to 14 (IQR, 13–15), 13 (IQR, 12–14), 12(IQR, 10.5– 12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1±3.4mmHg. TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants. Abbreviations: AC = anterior chamber, BCVA = best-corrected visual acuity, IOP = intraocular pressure, IPE = iris pigment epithelium, IQR = interquartile range, LPI = laser peripheral iridotomy, PDS = pigment dispersion syndrome, PG = pigmentary glaucoma, TM = trabecular meshwork, VA = visual acuity, VFA = Humphrey visual field analysis.

目的 探讨虹膜色素上皮(iris pigment epithelium,IPE)层色素颗粒对兔眼小梁切除术后滤过通道瘢痕化过程及Tenon囊成纤维细胞增生的影响.设计实验研究.研究对象新西兰大白兔18只.方法 单眼做小梁切除手术模型.实验组巩膜瓣下放置0.1 ml(100 μg/ml)猪IPE层色素颗粒并保留,阳性对照组和阴性对照组分别放置0.4 mg/ml丝裂霉素C棉片和生理盐水棉片3分钟.术后观察眼压、滤过泡形态30天,并对滤过泡及其周边组织进行组织病理学检查.主要指标眼压、滤过泡形态、手术滤过区瘢痕化程度.结果 实验组、阳性对照组、阴性对照组兔眼术前平均眼压分别为(24.78±1.40)、(24.11±1.18)、(24.00±1.53)mmHg(F=0.241,P=0.789).术后30天平均眼压分别为(20.28±1.87)、(20.39±2.28)、(23.33±1.14)mmHg(F=22.500,P=0.000).实验组与阳性对照组无显著差异(P=0.86),实验组与阳性对照组均低于阴性对照组(P均=0.000).滤过泡平均存留时间分别为(28.17±1.72)、(27.00±2.37)、(10.67±1.97)天(F=138.592,P=0.000).组织病理学检查示实验组和阳性对照组兔眼滤过区结构相似,胶原纤维和瘢痕组织相对较少,而阴性对照组胶原纤维和瘢痕组织明显增生.结论 小样本量短期实验研究表明,IPE层色素颗粒可能阻止Tenon囊成纤维细胞增生过程,有助于延缓小梁切除术后滤过通道瘢痕化.

Understanding glaucoma is an endless process of continuous integration; for example glaucoma, which was firstly recognized to be a disease limited to the eye, has now been considered as a disease affecting the whole visual pathway with the characteristics of optic nerve injury in addition to corresponding visual field defects. Relevant contents have been elaborated in Chap. 6 . In the process of overall integration, medical imaging technology plays an important role. There are varied approaches to study the characteristics and mechanisms of human diseases, especially with the booming progress of life science and modern molecular biology, so that the research can be carried out at the cellular level and molecular level. However, molecular biology has its insurmountable weakness—the limitation of the research object, as researchers can only inspect with clues from all kinds of animal models, autopsy of dead patients, and a small amount of local tissue from patients, and then infer to the human body. Only by morphological and functional observation in vivo could we understand the disease most authentically and effectively, which was barely possible for molecular biological method to achieve, while fortunately the imaging technology provides a means to realize the above purpose. This section discusses the role of neuroimaging techniques in understanding the process of damage to CNS by glaucoma, and it is hopefully that through reading this chapter, the readers would be able to understand advanced neuroimaging techniques used in ophthalmology nowadays; thus they would integrate the research methods of both molecular biology and imaging, the local part as the eye and the whole entire body, to provide new ideas and methods for further understanding glaucoma and other ophthalmic and nervous system diseases.

目的 探讨超声睫状体成形术(UCP)治疗难治性青光眼的有效性及安全性.方法 收集首都医科大学附属北京同仁医院眼科中心确诊的难治性青光眼患者11例(11只眼)的临床资料.其中,男性6例(6只眼),女性5例(5只眼),年龄28～68岁,平均年龄(48.0±20.4)岁.11例患者中1例为原发性闭角型青光眼术后眼压失控,5例为玻璃体切除术后或其它疾病引起的继发性青光眼,3例为新生血管性青光眼,2例为原发性开角型青光眼术后眼压失控.所有患者术前均经最佳矫正视力检查、裂隙灯显微镜眼底检查、眼压测量、光学生物测量及超声生物显微镜检查.行UCP术后,以平均眼压降低幅度和6个月后的手术成功率来评估UCP治疗的有效性.数据以平均值 ± 标准差(-x±s)表示.数据缺失时,采用混合效应模型比较不同时间点的眼压变化;采用Wilcoxon检验比较术前与术后降眼压药物使用数量的变化;采用线性回归分析比较术前及其与术后眼压降低差值的关系.结果 11例患者(11只眼)全部接受UCP手术治疗,术后3个月的手术成功率为54％(6/11),术后6个月的手术成功率为36％(4/11).术前、术后7 d、3个月及6个月的平均眼压分别为(40.82±3.47)mmHg(1 mmHg=0.133 kPa)、(20.26±3.43)mmHg、(19.89±4.35)mmHg及(22.06±5.15)mmHg.与术前比较,差异均有统计学意义(t=-4.23,-3.80,-3.05;P<0.05).术后6个月,每日降眼压药的使用数量明显降低,平均降压药物由(3.09±0.3)种降至(2.3±0.2)种,且两者差异有统计学意义(Z=7.27,P<0.05).结论 UCP术后6个月能有效地降低眼压,但其术后效果的长期评价仍需观察.

Glaucoma is one of the leading course of irreversible blindness worldwide, of which the main characteristics include pathological high intraocular pressure and visual field defect. Filtration surgery plays an important role in the treatment of glaucoma. However, postoperative scarring of the filtration chan-nel resultant from excessive proliferation of Tenon's capsule fibroblasts ( TCFs) reduces the long-term suc-cess rate of the surgery. In recent years, it has been suggested that presence of pigment granules in anterior segment of the eyeball may inhibit the proliferation of TCFs, which provides a novel thought and research di-rection for intro-and postoperative management of scarring in filtration surgery.

正常眼压性青光眼(normal tension glaucoma,NTG)是青光眼中的特殊类型,发病隐匿,机制未明,可能与视神经乳头血流灌注异常有关,如系统性低血压、全身或局部血管狭窄、眼部血流量下降、视神经乳头血流调控异常等,并最终导致视乳头和巩膜筛板血流灌注降低,发生NTG.